Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; School of Pharmacy, Chongqing Medical University, Chongqing, China.
Phase I Clinical Trial Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Int Immunopharmacol. 2019 May;70:354-361. doi: 10.1016/j.intimp.2019.03.002. Epub 2019 Mar 7.
Idiopathic membranous nephropathy (IMN) is a common cause of nephrotic syndrome in adults and one of the leading causes of end-stage renal disease (ESRD). During recent years, the incidence of IMN has been increasing. The main treatment option for IMN is the use of immunosuppressive (IS) drugs combined with glucocorticoids (GC). However, the infection risk with different IS drug treatments has not been systematically compared. Therefore, a network meta-analysis was performed to compare the risk of infection of different IS drug treatments for IMN.
Randomized controlled trials (RCTs) that assessed the risk of infection in patients with IMN treated with different IS drugs combined with GC were included in the network meta-analysis. Risk ratios for dichotomous data with 95% confidence intervals (CI) were calculated and the data were pooled with a random-effects model. The surface under the cumulative ranking area (SUCRA) was calculated to rank the risk of infection with different interventions.
A total of 38 RCTs with 2066 participants were included for comparison of nine interventions. Tacrolimus combined with GC (TAC + GC) was associated with a significantly lower risk of infection than that with intravenous cyclophosphamide (IVCTX) + GC with a risk ratio (95% CI) of 0.52 (0.34-0.79). IVCTX + GC was associated with a significantly higher risk of infection than that with TAC + GC, cyclosporin (CSA) + GC, and oral cyclophosphamide (POCTX) + GC. A sensitivity analysis, excluding studies with a very long follow-up period, revealed minimal differences in the estimates. The SUCRA showed that CSA + GC had the lowest risk of infection (SUCRA 86.0%), and the second best treatment was POCTX + GC (SUCRA 78.6%). Conversely, IVCTX + GC (SUCRA 16.2%) had a higher risk of infection than that with the other IS drugs.
CSA + GC and POCTX+ GC were associated with a lower risk of infection than that with other IS drugs combined with GC for IMN. Combined with comparative efficacy data, these results can help patients make informed decisions about treatment options for IMN. PROSPERO registration: CRD42018104849.
特发性膜性肾病（IMN）是成人肾病综合征的常见病因之一，也是终末期肾病（ESRD）的主要原因之一。近年来，IMN 的发病率一直在上升。IMN 的主要治疗选择是使用免疫抑制（IS）药物联合糖皮质激素（GC）。然而，不同 IS 药物治疗的感染风险尚未系统比较。因此，进行了一项网状荟萃分析，以比较不同 IS 药物治疗 IMN 的感染风险。
纳入了评估 IMN 患者接受不同 IS 药物联合 GC 治疗时感染风险的随机对照试验（RCT）。使用二项数据的风险比和 95%置信区间（CI）进行计算，并使用随机效应模型对数据进行合并。计算不同干预措施感染风险的累积排序曲线下面积（SUCRA）以进行排序。
共纳入 38 项 RCT 共 2066 名参与者，比较了 9 种干预措施。与静脉注射环磷酰胺（IVCTX）+GC 相比，他克莫司联合 GC（TAC+GC）感染风险显著降低，风险比（95%CI）为 0.52（0.34-0.79）。IVCTX+GC 与 TAC+GC、环孢素（CSA）+GC 和口服环磷酰胺（POCTX）+GC 相比，感染风险显著增加。一项敏感性分析，排除随访时间非常长的研究，结果估计差异极小。SUCRA 显示 CSA+GC 感染风险最低（SUCRA 86.0%），其次是 POCTX+GC（SUCRA 78.6%）。相反，IVCTX+GC（SUCRA 16.2%）的感染风险高于其他 IS 药物。
CSA+GC 和 POCTX+GC 与其他 IS 药物联合 GC 治疗 IMN 相比，感染风险较低。结合比较疗效数据，这些结果可以帮助患者对 IMN 的治疗选择做出明智的决策。PROSPERO 注册：CRD42018104849。
